Chapter 10 Nutrition Copyright 2018 Elsevier Inc All

Chapter 10 Nutrition Copyright © 2018, Elsevier Inc. All rights reserved.

Nutrition The key element is preserving the health of older adults The quality and quantity of a diet will help prevent, delay the onset of, and manage chronic disease processes Fulfillment of nutritional needs in aging is often affected by numerous factors Copyright © 2018, Elsevier Inc. All rights reserved. 2

U. S. Dietary Guidelines Generally, older adults need fewer calories Still require same or higher levels of nutrients Limit intake of saturated fat and trans fatty acids Fiber intake is generally lacking in older adults Vitamin intake is generally good for older adults; they should increase the consumption of the crystalline form of vitamin B 12 Copyright © 2018, Elsevier Inc. All rights reserved. 3

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Obesity Usually, older adults are viewed as underweight and frail; however, the concern of obesity in older adults is increasing Obesity is associated with increased health care costs, functional impairments, disability, chronic disease, and nursing home admission Weight loss recommendations for older adults must be carefully considered on an individualized basis Copyright © 2018, Elsevier Inc. All rights reserved. 5

Malnutrition Recognized geriatric syndrome Rising incidence in all settings Has serious consequences, including infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, prolonged hospital stays, institutionalization, and increased morbidity and mortality Copyright © 2018, Elsevier Inc. All rights reserved. 6

Characteristics of Malnutrition Complex syndrome that develops along two primary trajectories One occurs when the person does not consume sufficient micronutrients and macronutrients to maintain organ function and healthy tissue Ø Inflammation-related malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that increase metabolic rate and impair nutrient use Ø Copyright © 2018, Elsevier Inc. All rights reserved. 7

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Factors Affecting Fulfillment Lifelong eating habits Acute and chronic illness Medication regimens Ethnicity and culture Ability to obtain and prepare food Mood Socialization Socioeconomic deprivation Transportation and housing Food knowledge Copyright © 2018, Elsevier Inc. All rights reserved. 9

Lifelong Eating Habits Are developed out of tradition, ethnicity, and religion Reflects the individual’s dietary history and present food practices Older adults may fall prey to advertisements that claim specific foods can reverse aging or rid them of chronic conditions Essential nutrients should be obtained from food sources rather than supplements Copyright © 2018, Elsevier Inc. All rights reserved. 10

Socialization Older adults may be isolated from social events during which food is provided Effects of medications or a disease process may cause a disinterest in food Excessive drinking decreases eating habits Copyright © 2018, Elsevier Inc. All rights reserved. 11

Chronic Diseases Functional and cognitive impairments associated with chronic disease interfere with the ability to shop, cook, and eat independently Medication side effects may further impair nutritional status Dysphagia can be the result of behavioral, sensory, or motor problems and is common in those with neurologic disease and dementia Copyright © 2018, Elsevier Inc. All rights reserved. 12

Assessment of Dysphagia Obtain a history of the response to dysphagia Observe the person during mealtime Determine risk for aspiration Assume those referred for a dysphagia evaluation (“swallowing study”) are at risk for aspiration Maintain NPO status until the evaluation is completed Ø Nutrition and hydration needs can be met by intravenous, nasogastric, or gastric tubes Ø Copyright © 2018, Elsevier Inc. All rights reserved. 13

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Interventions for Dysphagia Goal: Safe oral intake to maintain optimal nutrition and caloric needs Compensatory interventions include Postural changes and proper positioning Ø Modification of bolus volume, consistency, temperature, and rate of presentation Ø Modified diets Ø Neuromuscular electrical stimulation Copyright © 2018, Elsevier Inc. All rights reserved. 15

Question The nurse is feeding an older adult patient with dysphagia after a stroke. Which intervention is most important when feeding this patient? A. B. C. D. Serve only pureed foods Offer small sips of fluid with each bite Place food on the impaired side of the mouth Have the patient swallow twice between each mouthful Copyright © 2018, Elsevier Inc. All rights reserved. 16

Answer D—Have the patient swallow twice between each mouthful. If facial weakness is present, place food on the nonimpaired side of the mouth. Alternate solids and liquid boluses. Not all persons require pureed foods. Copyright © 2018, Elsevier Inc. All rights reserved. 17

Implications for Gerontological Nursing and Healthy Aging Comprehensive nutritional screening and assessment are essential in identifying older adults at risk for nutrition problems or who are malnourished The role of nursing assessment and intervention should be comprehensive and include Increased attention to the process of eating and the entire ritual of meals Ø Assessment of nutritional status Ø Thorough medication review Ø Copyright © 2018, Elsevier Inc. All rights reserved. 18

Nutrition Screening Tools Nutrition Screening Initiative Checklist Mini Nutritional Assessment (MNA) Both a screening tool and a detailed assessment Ø Only valid for those older than age 65 years Ø Intended for use by professionals Ø Minimum Data Set (MDS) Food and nutrient intake 24 -Hour dietary recall Ø 3 -Day dietary history Ø Copyright © 2018, Elsevier Inc. All rights reserved. 19

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Nutrition Assessment Components Interview History Physical examination Anthropometric data Laboratory data Food and nutrient intake Functional assessment Copyright © 2018, Elsevier Inc. All rights reserved. 21

Nutrition Data Anthropometric measurements Height and weight Ø Midarm circumference Ø Triceps skinfold thickness Ø There is no single biochemical marker of malnutrition Ø Serum albumin level Copyright © 2018, Elsevier Inc. All rights reserved. 22

Interventions to Increase Food Intake Goal: Increase food intake and enhance and manage the environment to promote increased food intake Feeding assistance Ø Environment enhancements Ø Calorie supplements Ø Pharmacological therapy Ø Patient education Ø Copyright © 2018, Elsevier Inc. All rights reserved. 23

Implications for Gerontological Nursing and Healthy Aging (Cont. ) Knowledge of nutritional needs and the many factors contributing to inadequate nutrition is essential Use of evidence-based practice protocols is important in determining nursing interventions to support and enhance nutritional status Preventing undernutrition, malnutrition, and the maintenance of dietary needs are ethical responsibilities Copyright © 2018, Elsevier Inc. All rights reserved. 24

Question Which action should the nurse take first when teaching a widowed older patient living with his son about ways to improve nutrition? A. B. C. D. Recommend a liquid caloric supplement Determine who shops and prepares meals Arrange for weekly transportation to the store Collaborate with a social worker food stamps Copyright © 2018, Elsevier Inc. All rights reserved. 25

Answer B—Assessment is the first step in determining nutrition interventions. Copyright © 2018, Elsevier Inc. All rights reserved. 26